This study enabled the development of a brief, clinically fesible screening tool for falls and injury risk identification in older community-dwelling adults through a range of methods that included a literature review, a Case Note Audit of 128 people attending Falls and Balance clinic, and group,processes (Nominal Group and Delphi Panel with 12 and 10 participants respectively). These methods focussed on developing specifications for the screening tool, selecting key modifiable risk factors and associated tests for both falls and injury and considering questions that would determine self-perception of falls risk, general health and balance. The range of methods and process of triangulation ensured content validity of the tool. / thesis (MPhysiotherapy)--University of South Australia, 2002.

Although traditional prevention and management strategies for hamstring injuries have focussed on optimising muscle strength, flexibility and endurance, incidence and/or recurrence rates of these injuries remains high. A theoretical framework was developed considering additional factors that increase the stabilising demand of the hamstrings. These factors included loss of related stability at the knee and lumbopelvic regions and extrinsic factors during functional and sporting activities. The aims of this research were to determine whether electromyographic (EMG) derived hamstrings, quadriceps and gluteal muscle activation patterns as well as isokinetic torque generation patterns could differentiate athletes who had incurred a hamstring injury from uninjured control athletes. It was hypothesised that the EMG activity of the injured participants would be decreased compared to uninjured control participants during maximal activities, but increased during weight bearing activities. The research included the identification of laboratory-based tasks relevant to the function of the hamstring muscles; test-retest reliability of EMG variables recorded during these tasks; and a comparative cross-sectional study of hamstring-injured (hamstring group, HG) and control athletes (control group, CG). Electromyographic activation patterns were determined during assessment of concentric and eccentric isokinetic strength of the thigh muscles, during transition from double- to single-leg stance, and forward lunging. Isokinetic and EMG onset and amplitude variables were compared both within- and between-groups. Despite no significant differences for peak torque, the HG injured limb generated lower average eccentric flexor torque towards the outer range of motion in comparison to the HG uninjured limb (P = 0.034) and the CG bilateral average (P = 0.025). Furthermore, the EMG root mean square (RMS) decrease from the start to the end range of the eccentric flexor contraction was greater for the HG injured limb hamstrings than the CG bilateral average. During the transition from double- to single-leg stance, the EMG onsets of the HG injured limb (biceps femoris [BF] P < 0.001, medial hamstrings [MH] P = 0.001), and the HG uninjured limb (BF P = 0.023, MH P = 0.011) were earlier in comparison to the CG bilateral average. The transition normalised EMG RMS was significantly higher for the HG injured side BF (P = 0.032), MH (P = 0.039) and vastus lateralis (VL, P = 0.037) in comparison to the CG bilateral average. During the forward lunge, no significant differences were observed within- and between-groups for the normalised EMG amplitude prior to and following initial foot contact. These results suggest that during maximal isokinetic eccentric flexor contractions, the average torque and EMG activity is decreased towards the lengthened position of the hamstring-injured limb. This may be due to structural changes or neurophysiological inhibitory mechanisms. During the static weight bearing task an earlier onset of the HG hamstring muscles was evident in comparison to controls. The hamstrings and the VL of the injured limbs were activated at greater normalised amplitude. The increased muscle activation in the hamstring-injured limbs during the support phase may indicate a greater demand towards stability of the kinetic chain or changes in proprioceptive function. Future research should consider the mechanisms and clinical implications underlying a loss of eccentric flexor torque towards the outer range of contraction, and investigate why increased activation of thigh muscles occurs during the static weight bearing task in hamstring-injured athletes.

Reperfusion injury may mediate renal dysfunction following ischaemia. A murine model was developed to investigate the role of the tissue factor-thrombin-protease activated receptor pathway in renal ischaemia reperfusion injury (IRI). In this model, mice received 25 minutes of ischaemia and subsequent periods of reperfusion. C57BL6, protease activated receptor-1 (PAR-1) knockout mice, and tissue factor (TF) deficient mice were used. Following 24 hours IRI, PAR-1 deficiency resulted in protection against severe renal failure compared to the C57BL6 mice (creatinine, 118.2 ?? 6.3 vs 203 ?? 12 ??mol/l, p&lt0.001). This was confirmed by lesser tubular injury. By 48 hours IRI, this resulted in a survival benefit (survival, 87.5% vs 0%, p&lt0.001). Treatment of C57BL6 mice with hirudin, a specific thrombin inhibitor, offered renoprotection at 24 hours IRI (creatinine, 107 ?? 10 ??mol/l, p&lt0.001), leading to a 60% survival rate at 48 hours IRI (p&lt0.001). TF deficient mice expressing less than 1% of C57BL6 mouse TF were also protected (creatinine, 113.6 ?? 7 ??mol/l, p&lt0.001), with a survival benefit of 75% (p&lt0.001). The PAR-1 knockout, hirudin treated C57BL6 and TF deficient mice had reduced myeloperoxidase activity and tissue neutrophil counts compared to the C57BL6 mice, along with reduced KC and MIP-2 chemokine mRNA and protein expression. Hirudin treatment of PAR-1 knockout mice had no additional benefit over PAR-1 absence alone, suggesting no further contribution by activation of other protease activated receptors (creatinine at 24 hours IRI, 106.5 ?? 10.5 ??mol/l, p&gt0.05). Furthermore, immunofluoresence staining for fibrin(ogen) showed no difference between C57BL6 and PAR-1 knockout mice, suggesting no major contribution by fibrin in this model. Renal IRI resulted in increased levels of TF mRNA expression in the C57BL6, PAR-1 knockout, and hirudin treated C57BL6 mice compared to normal controls, suggesting that TF mRNA expression was upregulated in this model. This resulted in increased TF functional activity in the C57BL6 and PAR-1 knockout mice, but TF activity was negligible in hirudin treated C57BL6 and TF deficient mice. The data therefore suggests that the TF-thrombin cascade contributes to renal IRI by signalling via PAR-1 that then regulates chemokine gene expression and subsequent neutrophil recruitment.

Background: Agricultural workers in New Zealand have high rates of occupational injury compared to most other occupational groups. They are also over-represented in work-related fatal injury statistics. While it is recognised that the personal and social costs of occupational injuries to agricultural workers are considerable, the ability to develop and evaluate evidence-based injury control strategies for this group has been limited by the lack of quality information on occupational exposures and injury events. Aim: The aim of this thesis was to develop and pilot a comprehensive occupational exposure and acute injury outcome data collection system for agricultural workers which will provide an evidence base for a public health approach to acute occupational injury control within the agricultural sector of New Zealand. The thesis objectives were therefore to: * Develop study methods to collect occupational exposure and injury outcome information. * Assess the likely validity of these study methods. * Determine the feasibility of implementing the study methods. * Suggest modifications to the study methods to enhance their validity and feasibility. Methods: Pastoral farms in the Waitaki region of New Zealand were identified using a database of New Zealand farm owners. The owners and workers on these farms were contacted and asked to participate. Participants were required to complete an Initial Questionnaire which included items on farm and personal characteristics, the farm environment, training, safety perceptions and attitudes and safety behaviour. Participants were then monitored for six months. During the monitoring period each participant completed a monthly log of their work activities during the preceding week. Any work-related injuries to workers on participating farms were also recorded and reported monthly. Participants who were injured were followed up for an interview to obtain detailed injury event information. At the end of the monitoring period a second Questionnaire was administered to assess change during the study. Participants were asked about any occupational injury events during the study as part of one of the monthly logs and the second Questionnaire to provide a comparison measure to the monthly reports. A random third of participating farms were visited at the end of the study to assess the validity of participants� reports on the farm environment. Results: Sixty-two farms were recruited into the study, a recruitment rate of 24%. This resulted in 82 study participants. Fifty-seven farms and 72 participants completed the study, resulting in retention rates of 92% and 88% respectively. Return of study items was high, with the lowest observed level of return being 92%. Levels of response error were low in most of the study items, with exceptions being the recording of the hours spent handling animals (37%) and total hours worked (22%). Most postal items (over 68%) were returned before a reminder call was made. Participants� reports about the farm environment closely matched the observations made during the visits, with little evidence of significant misreporting. The validity of reported injury events during the study could not be determined, as the two methods of capturing injury events identified different events. Conclusions: Within the limitations of the study, most of the study methods appeared to be feasible and have acceptable validity. The low recruitment rate and issues with validating the capture of injury events indicated that modifications to the study design were necessary to achieve acceptable validity and feasibility, however. Recommendations were made on how feasibility and validity might be improved.

Perinatal hypoxia-ischaemia is a major cause of disability, including cerebral palsy, yet a neuroprotectant which fully protects the brain remains elusive. Following a hypoxic-ischaemic insult, striatal medium-spiny neurons and hippocampal CA1 neurons are vulnerable to a complex cascade of neurotoxic events. This cascade includes energy failure, a massive release of glutamate, the formation of free radicals and caspase activation. The overall aim of this thesis was to assess the efficacy of three potential neuroprotective strategies that target this cascade from different directions. Short-term, and where appropriate, long-term, neuroprotection was investigated. The first treatment strategy aimed to suppress the generation of free radicals through treatment with the potent free radical spin trap, N-tertbutyl-(2-sulphophenyl)-nitrone (S-PBN). The second compound tested was the caspase-3 inhibitor, minocycline. Finally, the third treatment strategy combined a series of S-PBN injections with 6 hours of moderate hypothermia immediately after hypoxia-ischaemia. Hypothermia is suggested to slow the rate of the neurotoxic cascade, thus potentially allowing other neuroprotective agents greater efficacy. Using an adaptation of the Rice et al. (1981) model, hypoxia-ischaemia was induced on postnatal day (PN) 8 in the right cerebral hemisphere. For the short-term studies, the rats were perfused at 14 days-of-age. The brains were dissected out and embedded in Technovit. Forty [mu]m serial sections were cut through the right striatum and hippocampus. The total number of medium-spiny neurons in the striatum and where appropriate, the total number of neurons in the hippocampal CA1 pyramidal layer, were stereologically determined using the optical disector/Cavalieri method. For the long-term study, fine motor control was assessed in half of the animals through the staircase test from 9-11 weeks-of-age. Neuroprotection was assessed in the remaining animals. All animals were sacrificed at 12 weeks-of-age. The total number of striatal medium-spiny neurons was stereologically determined in the non-behavioural animals as described above. A series of seven injections of S-PBN (100mg/kg) did not offer statistically significant neuroprotection to the striatum at one week after perinatal hypoxia-ischaemia. Similarly, a single injection of minocycline (45mg/kg) immediately after the insult did not offer significant neuroprotection to the striatum nor the CA1 region of the hippocampus at this early time-point. In contrast, when the series of S-PBN injections was combined with 6 hours of moderate hypothermia post-hypoxia-ischaemia, sterelogical analysis revealed significant neuroprotection of the striatal medium-spiny neurons to normal levels at one week after the injury. No significant neuroprotection was seen in the CA1 region of the same animals. To assess whether this impressive striatal neuroprotection was long-lasting and whether it represented functional rescue, the final experiment in this thesis investigated rat pups at 12 weeks-of-age after exposure to hypoxia-ischaemia at PN8. Treatment with S-PBN/hypothermia offered persistent neuroprotection of striatal medium-spiny neurons and preservation of fine motor skills compared to diluent-normothermia-treated controls. The long-term behavioural outcomes were compared with normal, uninjured controls and the total number of medium-spiny neurons was compared with normal numbers from the literature. These comparisons revealed that the histological and functional integrity of the striatum was rescued to normal levels. This is the first study to identify a treatment strategy that offers complete and long-lasting preservation of striatal neuronal numbers, by accurate and unbiased stereological methods, paired with persistent preservation of fine motor control following perinatal hypoxia-ischaemia.

"May 2004" / Bibliography: leaves 172-184. / xvi, 186 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (D.Nurs.)--University of Adelaide, Dept. of Clinical Nursing, 2004

x, 148 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.D. 1980) from the Dept. of Surgery, University of Adelaide

"July, 2001" / Addendum inserted in back. / Includes bibliographical references (leaves 250-284) / xxiii, 284 leaves : ill. (some col.), plates (some col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Surgery, 2001

Author's previously published articles appended. / Bibliography: leaves 292-341. / xviii, 388 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Psychology, 2005

PURPOSE: To compare glenohumeral joint position sense (JPS), concentric internal (IR) and external rotation (ER) strength, functional ability, and level of satisfaction in patients who underwent three types of glenohumeral capsulorrhaphy with age-matched controls. RESEARCH DESIGN: Four 4x2 and two 4x3 ANOVAs were used to identify differences in JPS and concentric IR/ER strength between groups: Open Capsulorrhaphy (n=21), Thermal Capsulorrhaphy (n=16), Arthroscopic Capsulorrhaphy (n=14) and Controls (n=22). Pearson correlation analyses were performed to determine the relationship between objective American Shoulder and Elbow Surgeons (ASES) evaluations and subjective Shoulder Rating Questionnaire (SRQ) scores. Stepwise multiple regression analyses were performed to predict ASES and SRQ scores from various objective and subjective outcome measures. SUBJECTS: 73 adults (51 postsurgical patients, 22 healthy controls; mean age, 23.7 ± 6.8 yrs) participated in this retrospective study. The 51 patients who underwent capsulorrhaphy for recurrent, anterior glenohumeral instability were evaluated at an average of 32.1 months postsurgery. MEASUREMENTS: JPS was measured bilaterally using a reproduction of passive positioning protocol at 2 target angles: 60% and 90% of maximum passive external rotation (60% and 90% ER[subscript max]). Concentric IR and ER peak torques were measured bilaterally at 90°/sec, 180°/sec and 270°/sec. Objective postoperative function was quantified with the clinician-based ASES form, while functional status and patient satisfaction were assessed with the patient-based SRQ form. RESULTS: The accuracy of JPS in patients' surgical limbs was similar to that present in their contralateral, uninjured shoulders at both target angles. The Open group demonstrated significantly better involved-limb JPS acuity (4.2° ± 1.9°) than the Arthroscopic group (6.8° ± 3.2°) and Control group (6.6° ± 3.5°) (p<.05). However, the Open group had 31% less IR strength than Control subjects and 33% less than the Arthroscopic group, with IR peak torques significantly less in their postsurgical shoulders than their uninvolved limbs (p<.002). There was a strong, positive correlation (r =.64, p≤.001) between objective ASES and subjective SRQ scores. Patients' postoperative level of pain and ASES scores were significant predictors of their SRQ clinical scores (R=.81, p<.003). CONCLUSIONS: Glenohumeral JPS and rotator cuff strength were similar in both the postsurgical and uninvolved shoulders of the Arthroscopic and Thermal groups. Patients in the Open capsulorrhaphy group demonstrated significantly better involved-limb JPS than Arthroscopic and Control groups. The large strength deficits observed in the Open group, particularly in IR, were of significant concern. We observed a higher failure rate, more revision surgeries, and lower patient satisfaction with the Thermal capsulorrhaphy technique. Patient-based outcomes were significant predictors of operative success as measured by clinician-based evaluation. Prospective, randomized controlled studies are still needed to evaluate the outcomes of these glenohumeral capsulorrhaphy procedures over the longer term. / Graduation date: 2005